Find Your Routine: Consistency is Key
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our new series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them.
This week, we talked with Crystal Junkins, CCS, CPC, Coding Specialist with Health Information Associates, about the steps she takes to find her routine.
Q: Describe in detail your daily routine.
A: I’m an early bird – and so is my baby. I am up at 5:30 to feed the baby and have my first cup of coffee. I make breakfast for the two of us, and then switch off baby duty with my husband and the dog and I head upstairs to my office by 7:00. I read emails and go through my pending charts list, and then code until coffee break around 10. I code again until lunch and then break to feed the baby, and let the dog out. I finish coding around 3 in the afternoon, and then head right out the door to pick up the older kids from school – and then it’s homework, various sports and music lessons, prepping and eating dinner, reading, and then bedtime.
Q: How do you maintain your routine day after day, week after week?
A: I think I am just naturally a creature of habit. Health is a real priority, eating right, taking care of myself, getting enough sleep… all of that helps me maintain a regular rhythm at work as well as in my personal life as a mom to 3 busy boys. Our family life is so full of various schedules and responsibilities that the daily/weekly routine is pretty much created for me.
As far as coding goes, one obstacle I have noted to maintaining a rhythm mainly occurs when I am switching to a new client. I have often found it very challenging to start at a new client, especially since it definitely slows down my productivity quite a bit at first. However, I know that it has been a great asset for me professionally to learn how to adapt quickly to new clients, new relationships, new software, and new ways of approaching coding. HIA is constantly pushing me to grow, and that’s definitely one of the things I love about working here! So when I am starting a new client, I try to take some time to figure out the best workflow for that particular site, as it can vary so much from one place to another. They all abstract a bit differently or store their documents and information in new places. And then once I get into a fluent workflow, I stick with it. I generally go through every chart exactly the same way (abstract/discharge disposition, admit order, CDI notes, H&P, Discharge Summary, Op notes, Consults, Progress notes, anesthesia notes, labwork/etc). I think being consistent in this way helps me hit my productivity numbers at a new client faster.
Q: What techniques have you found to minimize distractions?
A: One thing that is very helpful is just the location of my office in our home. I am upstairs tucked away in a spare bedroom, far from the kitchen and living room downstairs which is often a bustle of activity between the comings and goings of my husband, the dog, the 2 older boys, the baby and the nanny who watches him during the day while I work. I really can’t hear much of anything up there! I also leave my cell phone on the charger in the kitchen during the day and just check it when I come downstairs for lunch or coffee. I focus a lot better when it’s quiet, so I usually don’t have music playing either.
Q: What are the productivity goals that you set for yourself? And how do you track them?
A: Well – it’s great that HIA does the productivity tracking for me! I just try to log in and do my best every day. Some days seem to flow really smoothly and feel easily productive. And then some days… just feel really slow and challenging. I try not to worry about the numbers and just figure that the good and the bad days will balance each other out in the end.
Q: What motivates you the most? Positive feedback from managers, self-motivation by reaching personal goals, financing incentives? Or other?
A: Yes, all of those things are motivating. But mostly, I just like to end every day feeling like I did a good job. My dad told me that was the most important thing – and he’s right.
TIP: I know for sure that I am not the fastest chart reader around, but I am definitely a fast typer. I am a piano performance graduate – so I know I have a head for memorizing information and fast fingers.
I am sure typing fast helps a lot, but more importantly, I think I am always looking for ways to type less. I know that CAC programs can be controversial, but I definitely make use of it as a tool when I am working for a client who is utilizing auto suggested codes. I use the CAC codes as much as possible, when I am confident that the suggested codes are correct. At first I was hesitant to use the codes the CAC was suggesting, but now that I am becoming more familiar with the I10 codes, I can save a lot of time by entering the codes and POA status through the CAC instead of typing it all in. The fewer key strokes the better! I know my productivity has gone up since I started making better use of the CAC.
In the past, there had been an Excludes1 note at I46.- Cardiac arrest that excluded R57.0, Cardiac shock. HIA had also received a letter from AHA on a case in the past that had stated that only I46.- Cardiac arrest would be coded if both were documented. In addition, the Third Quarter Coding Clinic page 26 had a similar case that asked if both could be coded, and AHA had instructed that only I46.9, cardiac arrest, cause unspecified would be coded if both were documented and that the CDC would be looking at possible revision to the Excludes1 note.
A higher CMI corresponds to increased consumption of resources and increased cost of patient care, resulting in increased reimbursement to the facility from government and private payers, like CMS. We know that documentation directly impacts coding.
Lately we have seen several cases where the endarterectomy was assigned along with the coronary artery bypass (CABG) procedure when being performed on the same vessel to facilitate the CABG. A coronary artery endarterectomy is not always performed during a CABG procedure, so when it is performed it becomes confusing as to whether to code it separately or not.
Assign code Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases” for all patients who are tested for COVID-19 and the results are negative, regardless of symptoms, no symptoms, exposure or not as we are in a pandemic.
The Centers for Medicare & Medicaid Services (CMS) announced new procedure codes for treatments of COVID-19 – effective as of August 1, 2020. Among the new codes are Section X New Technology codes for the introduction or infusion of therapeutics including Remdesivir, Sarilumab, Tocilizumab, transfusion of convalescent plasma, as well as introduction of any other or new therapeutic substances for the treatment of COVID-19.
One common element in many value-based programs is risk adjustment using Hierarchical Condition Categories (HCCs) to create a Risk Adjustment Factor (RAF) score. This method ranks diagnoses into categories that represent conditions with similar cost patterns.
Why are so many AKI records being denied? It’s hard to give one answer for why so many AKI records are being denied lately, but most appear to be due to the multiple sets of criteria available for use in determining if a patient has AKI, as well as physician documentation. As stated in Part 3 of this series, there are three main criteria/classifications used to diagnose AKI.
In previous parts of this series we looked at the definitions of AKI/ARF, causes, coding and sequencing, and the common clinical indicators that patients present with that are diagnosed with this condition. In Part 4, we will look at the documentation that should be present to report the diagnosis without fear of denial, as well as when a query is needed to clarify the diagnosis.
If the facility does a COVID-19 test, and test is negative, do I need a diagnosis code. The answer is yes, you will report a Z-code. The Z-code depends on the record documentation and circumstances of testing. For any patient receiving a COVID-19 test, if negative, there MUST e a Z-code to describe why the test was taken. (Test negative for COVID-19 and MD does not override negative results).
In the first parts of this series we looked at definitions of AKI/ARF, causes, coding and sequencing. In Part 3, we will look at what clinical indicators would possibly be present to support the diagnosis of AKI/ARF.
The FY2021 IPPS Proposed Rule is out and here are some highlights from it regarding ICD-10 Code proposals. We will know if these changes are permanent after the public comment period is over on July 10, 2020 and CMS prepares the Final Rule, usually out by August 1.
As discussed in Part 1 of this series, AKI/ARF is a common diagnosis that coders see daily. In Part 2, we are going to focus on the different types/specificity of AKI/ARF. We’ll learn what they mean, as well as how to code the diagnosis.
This is part 1 in a series focused on coding of acute kidney injury (AKI) and/or acute renal failure (ARF). AKI/ARF is reported often, but is also one of the most common diagnosis found in denials.
With the proliferation of COVID-19 cases, we thought we would put together a quick reference listing of some of the common scenarios that coders have asked about. As with all coding, coders should follow Official Guidelines for Coding and Reporting and the COVD-19 Frequently Asked Questions document by the AHA.
Effective March 1, Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19. This great for providers whose patients are reluctant to visit the office.
The biggest reasons why some hospital systems are moving to single path coding is to eliminate duplicative processes and to optimize productivity. In addition, costs are reduced when only one coder “touches” the record and completes both types of coding.
Effective with 4/1/2020 discharges, ICD-10-CM code U07.0 is used to report vaping -related disorders. ICD-10-CM code U07.0 (vaping related disorder) should be used when documentation supports that the patient has a lung-related disorder from vaping. This code is found in the new ICD-10-CM Chapter 22. U07.0 will be in listed in the ICD-10-CM manual under a new section: Provisional assignment of new disease of uncertain etiology or emergency use.
The US government and public-health officials are urging consumers to utilize telemedicine for remote treatment, fill prescriptions and get medical attention during the new coronavirus pandemic. The goal is to keep people with symptoms at home and to practice social distancing if their condition doesn’t warrant more intensive hospital care.
Coronavirus: Tips for working from home. Companies around the world have told their employees to stay home and work remotely. Whether you’re a new to this concept or a work from home veteran, here’s some tips to staying productive from our #HIAfamily.
This is the final part of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we provide an actual example of an effective communication response to CDI.
This is part two of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we discuss mismatches and how to best go about resolving them. In part three we will provide a case example of best practice interaction.
This is part one of a three part series in which we address how coders can better interact with Clinical Documentation Integrity (CDI) professionals. Many times these departments are separate and the remote environment makes it difficult to interact efficiently between the two departments. In part one, we will discuss the history and objectives of CDI so the coder has a better understanding of CDI’s role.
One reason that coders should report chronic conditions (including history and status codes) on outpatient records is the HCC’s—Hierarchical Condition Categories. The quick and easy explanation of what HCC’s are is each HCC is mapped to certain ICD-10-CM codes or code ranges. HCC coding is designed to estimate future health care costs for patients.
For Part 4 of this 5-part series, we will look at Chapter 10 within ICD-10-CM—J00-J99—Diseases of the Respiratory System. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
For Part 3 of this 5 part series, we will look at Chapter 9 within ICD-10-CM—I00-I99—Diseases of the Circulatory System. This chapter contains so many of the everyday diagnoses that we code such as hypertension, heart disease and stroke.
For Part 2 of this 5-part series, we will look at Chapter 1 within ICD-10-CM—A00-B99—Certain Infectious and Parasitic Diseases. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
For Part 1 of this 5-part series, we will look at Chapter 21 within ICD-10-CM—Z00-Z99—Factors influencing health status and contact with health services. There is no possible way to include every guideline or coding reference for this chapter, but I’ll do my best to touch on some off the most common issues.
The HIM world has been buzzing recently with discussion of “Social Determinants of Health” and coded data. What does this mean for coders and the HIM field?
In response to the recent occurrences of vaping related disorders and in consultation with the World Health Organization (WHO) Framework Convention on Tobacco Control, the WHO Family of International Classifications (WHOFIC) Network Classification and Statistics Advisory Committee (CSAC) was convened to discuss a diagnosis code for vaping related illness for immediate use.